Levosimendan in patients with left ventricular dysfunction undergoing cardiac surgery: a meta-analysis and trial sequential analysis of randomized trials

Scientific Reports
Zhenhua XingXinqun Hu

Abstract

Patients with left ventricular dysfunction (LVD) undergoing cardiac surgery have a high mortality rate. Levosimendan, a calcium sensitizer, improves myocardial contractility without increasing myocardial oxygen demand. It is not clear whether levosimendan can reduce mortality in cardiac surgery patients with LVD. The PubMed, Embase, and Cochrane Central databases were searched to identify randomized trials comparing levosimendan with conventional treatment in cardiac surgery patients with LVD. We derived pooled risk ratios (RRs) with random effects models. The primary endpoint was perioperative mortality. Secondary endpoints were renal replacement treatment, atrial fibrillation, myocardial infarction, ventricular arrhythmia, and hypotension. Fifteen studies enrolling 2606 patients were included. Levosimendan reduced the incidence of perioperative mortality (RR: 0.64, 95%CI: 0.45-0.91) and renal replacement treatment (RR:0.71, 95%CI:0.52-0.95). However, sensitivity analysis, subgroup analysis and Trial Sequential Analysis (TSA) indicated that more evidence was needed. Furthermore, levosimendan did not reduce the incidence of atrial fibrillation (RR:0.82, 95%CI:0.64-1.07), myocardial infarction (RR:0.56, 95%CI:0.26-1.23), or vent...Continue Reading

References

Dec 23, 2004·Journal of Clinical Epidemiology·Thomas A TrikalinosUNKNOWN EU-PSI project
Jul 15, 2005·JAMA : the Journal of the American Medical Association·John P A Ioannidis
Jun 6, 2006·Journal of Cardiothoracic and Vascular Anesthesia·Emad Al-ShawafRiad Tarazi
Mar 23, 2007·Anesthesia and Analgesia·Stefan G De HertPhilippe J Van der Linden
Dec 7, 2007·Interactive Cardiovascular and Thoracic Surgery·Necmettin YakutAli Gurbuz
Dec 18, 2007·Journal of Clinical Epidemiology·Jørn WetterslevChristian Gluud
Aug 25, 2009·Journal of Cardiothoracic and Vascular Anesthesia·Giovanni LandoniAlberto Zangrillo
Jan 1, 2010·BMC Medical Research Methodology·Jørn WetterslevChristian Gluud
Feb 16, 2010·The Journal of Thoracic and Cardiovascular Surgery·Manjula MagantiVivek Rao
May 26, 2010·Critical Care : the Official Journal of the Critical Care Forum·Alexandre MebazaaFerenc Follath
Jan 25, 2011·British Journal of Anaesthesia·H LeppikangasL Lindgren
Sep 24, 2011·The Annals of Thoracic Surgery·Khaled D AlgarniTerrence M Yau
Nov 5, 2011·Journal of Cardiothoracic and Vascular Anesthesia·Vladimir V LomivorotovAlexander M Karaskov
Dec 17, 2011·The Journal of Thoracic and Cardiovascular Surgery·L David HillisUNKNOWN American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines
Sep 21, 2013·Journal of Cardiothoracic and Vascular Anesthesia·Robert W HarrisonJohn H Alexander
Jan 23, 2014·Journal of Cardiothoracic and Vascular Anesthesia·Ayse BaysalCengiz Koksal
Jan 28, 2014·European Journal of Heart Failure·Francesco FedeleMassimo Mancone
Mar 14, 2014·JACC. Heart Failure·Milton PackerUNKNOWN REVIVE Heart Failure Study Group
Dec 18, 2015·Circulation·UNKNOWN Writing Group MembersUNKNOWN Stroke Statistics Subcommittee
Feb 18, 2016·International Journal of Cardiology·P PolleselloV-P Harjola
Sep 28, 2016·Journal of Cardiothoracic and Vascular Anesthesia·Vladimir V LomivorotovAlexander M Karaskov
Mar 21, 2017·The New England Journal of Medicine·Rajendra H MehtaUNKNOWN LEVO-CTS Investigators
Mar 23, 2017·The New England Journal of Medicine·Giovanni LandoniUNKNOWN CHEETAH Study Group

❮ Previous
Next ❯

Software Mentioned

Trial Sequential Analysis Viewer
Review Manager ( RevMan )
Review Manger
Cochrane Reviewer s Handbook
Cochrane Reviewer Handbook

Related Concepts

Related Feeds

Arrhythmia

Arrhythmias are abnormalities in heart rhythms, which can be either too fast or too slow. They can result from abnormalities of the initiation of an impulse or impulse conduction or a combination of both. Here is the latest research on arrhythmias.

Atrial Fibrillation

Atrial fibrillation is a common arrhythmia that is associated with substantial morbidity and mortality, particularly due to stroke and thromboembolism. Here is the latest research.

Atrial Filbrillation

Atrial fibrillation refers to the abnormal heart rhythm characterized by rapid and irregular beating of the atria. Here is the latest research.

Cardiomyopathy

Cardiomyopathy is a disease of the heart muscle, that can lead to muscular or electrical dysfunction of the heart. It is often an irreversible disease that is associated with a poor prognosis. There are different causes and classifications of cardiomyopathies. Here are the latest discoveries pertaining to this disease.